Effect of tracheal suctioning on aspiration past the tracheal tube cuff in mechanically ventilated patients

Beuret Pascal, Philippon Bénédicte, Fabre Xavier, Kaaki, Kaaki Mahmoud

Description

This clinical study evaluated the effect of a suctioning maneuver on aspiration past the cuff during mechanical ventilation. Methods Patients intubated for less than 48 hours with a PVC-cuffed tracheal tube, under mechanical ventilation with a PEEP ≥5 cm H 2 O and under continuous sedation, were included in the study. At baseline the cuff pressure was set at 30 cm H 2 O. Then 0.5ml of blue dye diluted with 3 ml of saline was instilled into the subglottic space just above the cuff. Tracheal suctioning was performed using a 16-French suction catheter with a suction pressure of – 400 mbar. A fiberoptic bronchoscopy was performed before and after the suctioning maneuver, looking for the presence of blue dye in the folds within the cuff wall or in the trachea under the cuff. The sealing of the cuff was defined by the absence of leakage of blue dye either in the cuff wall or in the trachea under the cuff. Results Twenty-five patients were included. The size of the tracheal tube was 7-mm ID for 5 patients, 7.5-mm ID for 16 patients, and 8-mm ID for four patients. Blue dye was never seen in the trachea under the cuff before suctioning and only in one patient (4%) after the suctioning maneuver. Blue dye was observed in the folds within the cuff wall in 6 of 25 patients before suctioning and 11 of 25 after ( p = 0.063). Overall, the incidence of sealing of the cuff was 76% before suctioning and 56% after ( p = 0.073). Conclusions In patients intubated with a PVC-cuffed tracheal tube and under mechanical ventilation with PEEP ≥5 cm H2O and a cuff pressure set at 30 cm H2O, a single tracheal suctioning maneuver did not increase the risk of aspiration in the trachea under the cuff. Trial registration ClinicalTrials.gov, number NCT01170156

Sujets

• Aspiration

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 97
• Langue: English

Extrait

Beuretet al. Annals of Intensive Care2012,2:45 http://www.annalsofintensivecare.com/content/2/1/45

R E S E A R C HOpen Access Effect of tracheal suctioning on aspiration past the tracheal tube cuff in mechanically ventilated patients * Pascal Beuret , Bénédicte Philippon, Xavier Fabre and Mahmoud Kaaki

Abstract Background:This clinical study evaluated the effect of a suctioning maneuver on aspiration past the cuff during mechanical ventilation. Methods:Patients intubated for less than 48 hours with a PVCcuffed tracheal tube, under mechanical ventilation with a PEEP≥5 cm H 2 O and under continuous sedation, were included in the study. At baseline the cuff pressure was set at 30 cm H 2 O. Then 0.5ml of blue dye diluted with 3 ml of saline was instilled into the subglottic space just above the cuff. Tracheal suctioning was performed using a 16French suction catheter with a suction pressure of–400 mbar. A fiberoptic bronchoscopy was performed before and after the suctioning maneuver, looking for the presence of blue dye in the folds within the cuff wall or in the trachea under the cuff. The sealing of the cuff was defined by the absence of leakage of blue dye either in the cuff wall or in the trachea under the cuff. Results:Twentyfive patients were included. The size of the tracheal tube was 7mm ID for 5 patients, 7.5mm ID for 16 patients, and 8mm ID for four patients. Blue dye was never seen in the trachea under the cuff before suctioning and only in one patient (4%) after the suctioning maneuver. Blue dye was observed in the folds within the cuff wall in 6 of 25 patients before suctioning and 11 of 25 after (p= 0.063). Overall, the incidence of sealing of the cuff was 76% before suctioning and 56% after (p= 0.073). Conclusions:In patients intubated with a PVCcuffed tracheal tube and under mechanical ventilation with PEEP ≥5 cm H2O and a cuff pressure set at 30 cm H2O, a single tracheal suctioning maneuver did not increase the risk of aspiration in the trachea under the cuff. Trial registration:ClinicalTrials.gov, number NCT01170156 Keywords:Tube cuff, Aspiration, Suctioning maneuver

Background The leakage of oropharyngeal secretions past high volume lowpressure tracheal tube cuffs is usually considered a major risk factor for bacterial tracheal colonization and subsequent development of ventilator associated pneumonia [1,2]. It has been demonstrated in a benchtop model that the rate of leakage around the cuff is related to the pressure differential across the cuff, namely the difference between the pressure of the subglottic fluid above the cuff and the tracheal pressure under the cuff [3]. Positive endexpiratory pressure

* Correspondence: pascal.beuret@chroanne.fr Intensive Care Unit, Centre Hospitalier Roanne, 28 rue de Charlieu, 42328 Roanne, France

(PEEP) improves the sealing around the cuff toward fluid leakage [46]. However, this preventive effect of PEEP may be compromised during prolonged mechanical ventilation by tracheal suctioning maneuver, which decreases tracheal pressure and enhances fluid leakage in vitro [3,7,8]. This clinical pilot study evaluated the effect of a suctioning maneuver on aspiration past the cuff dur ing conventional mechanical ventilation.

Methods Patients The study was approved by the Committee for protec tion of humans in biomedical research Sud Est I. During the time of the study, the patients who needed invasive

© 2012 Beuret et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.